title: Survival with 98% methemoglobin levels in a school-aged child during the "festival of colors".
abstract: Methemoglobin levels more than 70% have almost always been reported to have been fatal. The case of a 4-year-old boy who survived with methemoglobin levels of 98% is presented here. He was brought to the emergency department with complaints of vomiting, pain abdomen, and altered sensorium following accidental ingestion of paint thinner mixed with "Holi" colors. On examination, the child was in altered sensorium, cyanosed with saturations of 55%, who did not respond despite positive pressure ventilation with 100% oxygen. A possibility of toxic methemoglobinemia was considered and confirmed by finding of elevated methemoglobin levels of 98%. The child survived with definitive therapy with methylene blue and aggressive goal-directed approach.
authors.affiliation: From the Departments of Pediatrics, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi, India.
authors.forename: Jhuma
authors.initials: J
authors.lastname: Sankar
authors.forename: Shashikant
authors.initials: S
authors.lastname: Devangare
authors.forename: N K
authors.initials: NK
authors.lastname: Dubey
mesh_terms: D000059:Accidents; D000473:Alkanes / Q000506:poisoning; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000627:therapeutic use; D002562:Ceremonial Behavior; D002675:Child, Preschool; D003244:Consciousness Disorders / Q000139:chemically induced*; D005952:Glucose-6-Phosphatase / Q000097:blood; D006801:Humans; D006841:Hydrocarbons, Aromatic / Q000506:poisoning; D006846:Hydrocarbons, Halogenated / Q000506:poisoning; D007194:India; D008297:Male; D008706:Methemoglobin / Q000032:analysis*; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010150:Paint / Q000382:microbiology / Q000506:poisoning*; D011015:Pneumonia, Aspiration / Q000209:etiology*; D012997:Solvents / Q000506:poisoning*
chemical_list: D000473:Alkanes; D002511:Cephalosporins; D006841:Hydrocarbons, Aromatic; D006846:Hydrocarbons, Halogenated; D012997:Solvents; D008706:Methemoglobin; D005952:Glucose-6-Phosphatase; C004544:naphtha; D010100:Oxygen; D008751:Methylene Blue